DataBank Indicator

Children with Limitations

According to report by a parent or other adult household member, nearly one in five children, ages five to 17, (19 percent) had one or more limitations in 2013. These include limitations in normal physical activities due to health conditions and impairments, difficulty seeing, difficulty hearing, diagnosed learning disabilities, or difficulty bathing or showering without assistance.

Importance

Approximately 19 percent of Americans in 2010 had some level of disability, and 13 percent had a severe disability.[1]
A larger population of children are classified as having a disability today than in the past, and the primary reasons are increased birth and survival rates among very low birth weight infants (who have a high risk of disability) and increased diagnosis of Attention Deficit/Hyperactivity Disorder and asthma.[2]

One nationally representative study of children with limitations found that those limited in mobility, self-care, communication, or learning were more likely than other children to be exposed to second-hand smoke in their homes, to face cost and insurance barriers to medical care, and to have parents whose reported health status was poorer, compared with children without such limitations.[3] They lived in homes that had fewer resources (measured by poverty, family structure, and parental education), and were less safe.[4]

In 2013, among children with limitations, 24 percent were reported to be often unhappy, depressed, or tearful, compared with eight percent of children without limitations.[5] These symptoms among children with limitations may reflect, in part, frustration with environmental barriers that limit their ability to fully engage in home, school, community, or social activities, as well as the limiting conditions themselves.[6]

Trends

The proportion of children and adolescents, ages five to 17, who a parent or other adult household member reports as having at least one limitation remained relatively constant from 1998 to 2013, fluctuating between 17 and 20 percent. In 2013, the figure was 19 percent. (Figure 1)

Differences by Gender

Boys are more likely than girls to have at least one limitation. In 2013, 23 percent of boys were reported to have at least one limitation, compared with 15 percent of girls. The difference has narrowed slightly between 1999 and 2013. (Figure 1)

White and black children are more likely than Hispanic children to have at least one limitation. In 2013, 21 percent, each of white and black children were reported as having a limitation, compared with 17 percent of Hispanic children. Other children (primarily Asian) were the least likely to have a limitation. (Figure 2)

Differences by Health Insurance Coverage

Children with public health insurance are more likely than children with private insurance or no insurance coverage to have at least one limitation. Twenty-four percent of children with public health insurance had at least one limitation in 2013, compared with 17 percent, each of children with private insurance and children with no insurance. (Figure 3) This difference may reflect a higher prevalence of limitations among children in families with lower incomes, or it may be that families with these children are more likely to seek out public insurance in order to gain access to the care their children need.

Differences by Poverty Status and Receipt of Public
Assistance

In 2013, children in families below the poverty line were more likely to have a limitation than were children in families above the poverty line (25 versus 18 percent, respectively). Children in families with at least one member receiving income from welfare (TANF)[i] were much more likely to have a limitation than were children living in families not receiving these benefits (30 versus 19 percent, respectively). Similarly, 26 percent of children in families where at least one member was eligible to receive SNAP benefits (food stamps) had at least one limitation in 2013, compared with 17 percent among children in families not eligible to receive SNAP benefits. (Figure 4)

State and Local Estimates

Estimates of the proportion of children under age 5, and ages 5-17, with a disability (and, specifically, with hearing, vision, cognitive, ambulatory, and self-care difficulties) are available for states and larger sub-state regions from the American Community Survey.

International Estimates

National Goals

The Healthy People 2020 initiative has set a number of goals concerning children and youth with disabilities. These objectives include increasing the proportion of youth with special health care needs whose health care provider discusses transition planning from pediatric to adult health care, reducing the proportion of children and youth with disabilities younger than 21 who live in congregate residential care, and increasing the proportion of children and youth with disabilities who spend at least 80 percent of their time in regular education programs.

Definition

For this indicator, a child is identified as having a limitation if the child exhibits at least one of the following:

Difficulty seeing, even when wearing glasses or contact lenses;

Difficulty hearing without a hearing aid;

An impairment or health problem that limits his or her ability to crawl, walk, run or play;

Has been identified by a school representative or health professional as having a learning disability;

Has been identified by a school representative or health professional as having ADD/ADHD; or

Needs the help of other persons with bathing or showering.

Data are provided by an adult respondent, typically a parent.

This list of characteristics is not intended to be exhaustive of all limitations that should be included in the concept of childhood limitation, which may include a variety of chronic health conditions, impairments, developmental delays, and functional limitations. It is, instead, an operational definition that allows researchers to capture the largest group of children with any sort of limitation while using a limited set of identifying questions. For more information, see Hogan, D. P. and Wells, T. (2002). Developing concise measures of childhood limitations.

Data Sources

Original analysis by Child Trends of National Health Interview Survey data from 1998-2013.

1 A child is defined as having a limitation if the child exhibits at least one of the following limitations: difficulty seeing even when wearing glasses or contact lenses; difficulty hearing without a hearing aid; an impairment or health problem that limits his or her ability to crawl, walk, run or play; has been identified by a school representative or health professional as having a learning disability; has been identified by a school representative or health professional as having ADD/ADHD; or needs the help of other persons with bathing or showering. This list of characteristics is not intended to be exhaustive of all limitations that should be included in the concept of childhood limitation, which may include a variety of chronic health conditions, impairments, developmental delays, and functional limitations. It is, instead, an operational definition that allows researchers to capture the largest group of children with any sort of limitation while using a limited set of identifying questions. For more information, see Hogan, Dennis P. and Thomas Wells. 2002. “Developing Concise Measures of Childhood Limitations.” Unpublished manuscript, Brown University.2Persons of Hispanic origin may be of any race.

3Parental education reflects the education level of the most educated parent in the child’s household.

4Children covered by both public and private insurance are placed in the private insurance category.

5As defined here, public health insurance for children consists mostly of Medicaid or other public assistance programs, including State plans. It does not include children with only Medicare or the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/CHAMP-VA/Tricare).

6Excludes emergency rooms as a usual source of care.

7At least one family member receives benefit.

Source: Original analysis by Child Trends of National Health Interview Survey data 1998-2013.

Endnotes

[i] Temporary Assistance for Needy Families (TANF) “provides assistance and work opportunities to needy families by granting states the federal funds and wide flexibility to develop and implement their own welfare programs.” Definition from the Department of Health and Human Services, Administration for Children and Families, Office of Family Assistance
website at http://www.acf.hhs.gov/programs/ofa/